Recurrent Diabetic Ketoacidosis in Two Community Teaching Hospitals |
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| Affiliation: | 1. Internal Medicine Department, Carlos Haya Hospital, Malaga, Spain;2. CIBER Fisiopatologia de la Obesidad y la Nutricion (CB06/003), Malaga, Spain;3. Preventive Medicine Department, Malaga University, Malaga, Spain;4. Health Center “Ciudad Jardin,” Malaga, Spain;5. Research Laboratory, Internal Medicine Department, Carlos Haya Hospital, Malaga, Spain;6. Endocrinology and Nutrition Department, Virgen de la Victoria Hospital, Malaga, Spain;7. Biomedical Research Laboratory, Endocrinology and Nutrition Department, Virgen de la Victoria Hospital, Malaga, Spain;1. Department of Endocrinology, Tan Tock Seng Hospital, Singapore;2. Yong Loo Lin School of Medicine, Singapore;3. Duke-NUS Graduate Medical School, Singapore;4. Brenner Centre for Molecular Medicine, National University of Singapore, Singapore;1. Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York;2. Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York;3. Division of Pediatric Otolaryngology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;4. Department of Radiology, Jacobi Medical Center, Bronx, New York.;1. Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut;2. Department of Pediatrics, College of Medicine of Peoria, University of Illinois |
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| Abstract: | ObjectiveTo identify the factors that influence recurrent (one or more previous episodes) diabetic ketoacidosis (DKA), which we refer to as recurrent DKA, in two private community teaching hospitals.MethodsRetrospective chart review of the demographics, diabetes treatment regimens, diabetes education, medical comorbidities, medical insurance status, and mental illness/psychosocial factors of 80 patients with recurrent DKA who were admitted to the resident teaching services at two Birmingham, Alabama community teaching hospitals, Trinity Medical Center (TMC) and Princeton Baptist Medical Center (PBMC), between May 2006 and May 2012.ResultsThe average number of admissions for recurrent DKA was 2.5 per patient. Eighty-four percent of the episodes of recurrent DKA were due to omission of insulin; 44% of patients reported omission of insulin because of illness and 40% stopped insulin for unknown reasons. Medical illnesses, including infection, accounted for only 31% of recurrent DKA admissions.ConclusionOmission of insulin is the major cause of recurrent DKA. Psychosocial and socioeconomic factors contribute to poor adherence to therapy. Identifying these factors and instituting appropriate interventions may reduce the incidence of recurrent DKA. (Endocr Pract. 2013;19:829-833) |
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